Living on cruise ships is cost effective for elderly people

BMJ 2004;329:1065 (6 November), doi:10.1136/bmj.329.7474.1065-b

Janice Hopkins Tanne New York

Living on a cruise ship provides a better quality of life and is cost effective for elderly people who need help to live independently, according to a study published in the Journal of the American Geriatrics Society ( 2004;52: 1-4)[CrossRef][ISI][Medline].

…. says Lee Lindquist, instructor of medicine at Northwestern University’s Feinberg School of Medicine in Chicago, and a geriatrician at Northwestern Memorial Hospital. People older than 65 who enjoy travel, have good cognitive function, but need some help in daily living are ideal candidates for care on a cruise ship.

The typical resident in a US assisted living facility is an 80 year old (age range 66 to 94) widowed, white, ambulatory woman who needs help with about two activities of daily living, such as walking, bathing, toileting, feeding, dressing, and transfers (for example, from bed to chair).

Such people might do better on a cruise ship, at a similar cost, even for many years.
….
In the United States, an assisted living facility costs about $2360 (&#A3;1290; {euro}1850) a month or $28 689 a year. In the northeast and the west of the United States, costs are higher.

A one month cruise in November in the Caribbean would cost $2651. Living on board for the entire year would cost $33 260. The authors calculate that the long term cost for a person to live on a cruise ship from the age of 80 until his or her death would be $230 497 compared with $228 075 for an assisted living facility.

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Elder Abuse and Neglect Assessment

NOTE: To view the article with Web enhancements, go to:
http://www.medscape.com/viewarticle/493951

Terry Fulmer, PhD, RN, GNP, FAAN
Dermatol Nurs 16(5):473, 2004. &#A9; 2004 Jannetti Publications, Inc. Posted 12/17/2004

….
Elder abuse and neglect is a serious and prevalent problem that is estimated to affect 700,000 to 1.2 million older adults annually in this country. Only one in ten cases of elder abuse and neglect are reported and there is a serious underreporting by clinical professionals, likely due to the lack of appropriate screening instruments. Abuse, neglect, exploitation and abandonment are actions that can result in elder mistreatment (EM).

Best Tools
The Elder Assessment Instrument (EAI),[1,2,3] a 41-item Likert scale assessment instrument that has been in the literature since 1984. This instrument is comprised of seven sections that reviews signs, symptoms and subjective complaints of elder abuse, neglect, exploitation and abandonment. There is no “score”. A patient should be referred to social services if the following exists:

1. if there is any evidence of mistreatment without sufficient clinical explanation
2. whenever there is a subjective complaint by the elder of EM
3. whenever the clinician believes there is high risk or probable abuse, neglect, exploitation, abandonment

Target Population
The EAI is appropriate in all clinical settings and is completed by clinicians that are responsible for screening for elder mistreatment.

Validity/Reliability
The EAI has been used since the early 1980′s. The internal consistency reliability (Cronbach’s alpha) is reported at 0.84 in a sample of 501 older adults who presented in an emergency department setting. Test/retest reliability is reported at 0.83 [P less than 0.0001].

The instrument is reported to be highly sensitive and less specific. Strengths and Limitations The major strengths of the EAI are its rapid assessment capacity (the instrument takes approximately 12-15 minutes) and the way that it sensitizes the clinician to screening for elder mistreatment. Limitations include: no scoring system and weak specificity….

I. General Assessment
Very Good// Good// Poor// Very Poor// Unable to Assess
1. Clothing
2. Hygiene
3. Nutrition
4. Skin integrity
5. Additional Comments:

II. Possible Abuse Indicators
No Evidence Possible// Evidence Probable// Evidence Definite// Evidence Unable to Assess
6. Bruising
7. Lacerations
9. Various stages of healing of any bruises or fractures
10. Evidence of sexual abuse
11. Statement by elder re: abuse
12. Additional Comments:

III. Possible Neglect Indicators
No Evidence Possible// Evidence Probable// Evidence Definite// Evidence Unable to Assess
13. Contractures
14. Decubiti
15. Dehydration
16. Diarrhea
17. Depression
18. Impaction
19. Malnutrition
20. Urine burns
21. Poor hygiene
22. Failure to respond to warning of obvious disease
23. Inappropriate medications (under/ over)
24. Repetitive hospital admissions due to probable failure of health care surveillance
25. Statement by elder re: neglect
26. Additional Comments:

IV. Possible Exploitation Indicators
No Evidence Possible// Evidence Probable// Evidence Definite// Evidence Unable to Assess
27. Misuse of money
28. Evidence of financial exploitation
29. Reports of demands for goods in exchange for services
30. Inability to account for money/ property
31. Statement by elder re: exploitation
32. Additional Comments:

V. Possible Abandonment Indicators
No Evidence Possible// Evidence Probable// Evidence Definite// Evidence Unable to Assess
33. Evidence that a caretaker has withdrawn care precipitously without alternate arrangements
34. Evidence that elder is left alone in an unsafe environment for extended periods of time without adequate support
35. Statement by elder re: abandonment
36. Additional Comments:

VI. Summary
No Evidence Possible// Evidence Probable// Evidence Definite// Evidence Unable to Assess
37. Evidence of abuse
38. Evidence of neglect
39. Evidence of exploitation
40. Evidence of abandonment
41. Additional Comments:

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Internet an Important Health Tool, But Not for Seniors, Study Finds

http://fconline.fdncenter.org/pnd/189/story

Even as the Internet becomes an increasingly important resource for individuals making decisions about health and healthcare options, a national survey of older Americans by the Kaiser Family Foundation ( http://kff.org/ ) finds that less than a third of seniors age sixty-five and older have ever gone online, compared to more than two-thirds of those between the ages of fifty and sixty-four. According to the report, e-health and the Elderly: How Seniors Use the Internet for Health, only 20 percent of today’s seniors have gone online to look for health information, compared to 53 percent of fifty- to sixty-four-year-olds, who rank the Internet first on a list of media sources of health information. The survey also found that seniors whose annual household income is less than $20,000 a year, including most people on Medicare, are much less likely to have gone online than those with incomes between $20,000 and $49,000.

With the passage of Medicare reform that allows recipients to choose prescrip-tion drug discount cards, the federal Web site Medicare.gov ( http://medicare.gov/ ) has become an important resource for comparing the benefits of competing cards, but the survey finds that few seniors had gone online for such information. “We know that the Internet can be a great health tool for seniors, but the majority are lower-income, less well-educated, and not online,” said Kaiser president and CEO Drew Altman. “It’s time for a national discussion on how to get seniors online.”

“Online Health Information Poised to Become Important Resource for Seniors, But Not There Yet.” Kaiser Family Foundation Press Release 1/12/05. http://kff.org/entmedia/entmedia011205nr.cfm

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Legal help for seniors and their families

Elder-law attorneys specialize in issues from estate planning to health care to abuse.
By Jennifer Haupt http://www.csmonitor.com/2005/0112/p14s01-lifp.html?s=hns

….
Understanding older people as well as the law

That’s where elder-law attorneys can be particularly effective, because they have a knowledge of older people that allows them to ignore the myths about aging and competence while empathizing with the challenges seniors face. They also tend to have networks of other professionals – such as social workers – that they can call on.
….
“The most appropriate time to find an elder-care attorney is really before a crisis,” says Ginny Rice, an elder-law attorney in Webster Groves, Mo. “We see lots of children of elderly parents who have had a health or financial crisis and don’t know where to turn. By completing a durable power of attorney, naming someone else to take care of your health and financial issues when you’re unable to do it, you can avoid a lot of headaches. Otherwise, you may need to go to court to have a guardian appointed – which is expensive.”
….
If networking doesn’t produce results, experts suggest asking a family physician, an organization such as one of the local volunteer groups that deal extensively with the elderly, or the local or state bar association for a list of elder-law attorneys.

Online resources are also available. The National Academy of Elder Law Attorneys’ website (www.naela.org) provides a list of members who have passed the stringent Elder Law Association Certification test (CELA), accepted by the American Bar Association as the gold standard of expertise, as well as links to other organizations that focus on senior issues.
FindLaw.com (www.findlaw.com) offers a state-by-state locator of elder-law attorneys.

Once a potential lawyer has been identified, ask plenty of questions, experts advise. People need to see if they think they will be comfortable working with that person.
….

Anti-tremor mouse stops PC shakes

BBC NEWS http://news.bbc.co.uk/go/pr/fr/-/2/hi/technology/4340561.stm

A special adaptor that helps people with hand tremors control a computer mouse more easily has been developed.

The device uses similar “steady cam” technology found in camcorders to filter out shaking hand movements.

People with hand tremors find it hard to use conventional mice for simple computer tasks because of the erratic movements of the cursor on the screen.
….
The Assistive Mouse Adapter (AMA) is the brainchild of IBM researcher Jim Levine who developed the prototype after seeing his uncle, who has Parkinson’s disease, struggle with mouse control.

“I knew that there must be way to improve the situation for him and the millions of other tremor sufferers around the world, including the elderly.